Can this dent in my upper cheek be filled with filler? (Photos)

Question

I’ve had this dent in my cheek ever since I got my braces on about 9 years ago, I am now 24. It’s always there, but much more noticeable when I smile. It’s the most noticeable when I wear makeup. Is there anything I can do for it? I have regular dimples on both sides of my cheeks but this dent/dimple is much deeper.

George Yang, MD · Answer

Interesting problem. I have seen this type of dimple develop on a family friend's child. I remember distinctly, that the child fell hard and hit his cheek on a sharp coffee table corner and developed an initial facial indentation, which quickly filled in with a hematoma/bruise. It looked smooth initially, then later, developed into a slight indentation which worsed when the child smiles.
Reverse engineering what probably happened is that the coffee table corner indented the skin and may have caused a tear in the fat underneath, without breaking the skin. The fat healed but with a separation between the sides of the fat. The scar tissue in the center of the dent may be healed against some deeper muscles/layers, to cause the worsening when smiling.
When you smile the lifting of the corners of the mouth causes the cheek apples to mound up and bulge. Since there is a separation of the fat and scar tissue at the site of the dent, the fat around the dent bulges more, but the scar tissue which is not as spongy as fat, does not bulge out like the surrounding fat, thus causing the deepening of the dimple when you smile.
The filler may hide the "resting" indentation, but I suspect it will still indent and cause the "dimple" when you smile. There is a procedure called "subcision" which releases the skin from underlying scar tissue which is "tethering" the skin down. Subcision is typically used for acne scars and cellulite improvement, but these are indentations which are there "at rest" and we do not have to deal with an a "dynamic" indentation.
The reason for the deep dive is to explain what may be the cause the problem. Filler/subcision may reduce the resting indentation, but I am not sure what will happen when you smile hard.
Best,
Dr. Yang

Jonathan Kulbersh, MD · Answer

I appreciate your question and your photos. An indentation like this may be treated by some well-placed filler or by releasing the tissue, depending on the cause of the indentation. I recommend getting an assessment with a board-certified facial plastic surgeon who can determine the cause of the indentation and create the best treatment plan for you.

Amelia Damse, DO · Answer

The best results are usually achieved using a combination of treatments. Subscision of the scar, followed by dermal fillers or dermal grafting would improve the appearance quite a bit. Laser may or may not be required afterwards for skin resurfacing.

Jason Emer, MD · Answer

Facial sculpting and contouring can be created with well-placed fillers (Voluma, Countour, Radiesse, Bellafill) and Sculptra, which would give improvement in facial balance. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Nelson Lee Novick, MD · Answer

The judicious use of a robust HA filler, such as Restylane Lyft, can help to elevate and smooth the indentation. It is important to consult with an experienced, board certified cosmetic dermatogist injector. The resultant improvement should be immediate. Best of luck.

Michael I. Echavez, MD · Answer

A photo of your cheek when you are not smiling would be helpful to give you the best advice.  It is possible that a dermal filler could be of benefit to you, but difficult to know based only on the photos of you smiling that you submitted.

Nitin Bawa, MD · Answer

This type of hollow can easily be filled with filler. I like Juvederm Voluma for this type of volume loss although Radiesse is another option as Radiesse also helps to stimulate collaged development.

Leonard Grossman, MD · Answer

If there is no visible dent when your face is at rest, I would never fill it out with anything as it will deform the face. Get an evaluation by a plastic surgeon and possibly Botox or similar might be the best choice. I hope this helps and good luck from New York City plastic surgery

Somyos Kunachak, MD - Account Suspended · Answer

Hi Fierce90072,

This indentation is most likely caused by the attachment of the skin to the muscle of the fascia covering the muscle. This may be improved by releasing the attachment then filling up with fat or fillers.